Prognostic factors for resected cases with gallbladder carcinoma: A systematic review and meta-analysis

Tian-Run Lv; Jun-Ke Wang; Fu-Yu Li; Hai-Jie Hu

doi:10.1097/JS9.0000000000001403

Prognostic factors for resected cases with gallbladder carcinoma: A systematic review and meta-analysis

Int J Surg. 2024 Mar 28. doi: 10.1097/JS9.0000000000001403. Online ahead of print.

Authors

Tian-Run Lv¹, Jun-Ke Wang, Fu-Yu Li, Hai-Jie Hu

Affiliation

¹ Department of Biliary Surgery, West China Hospital, Sichuan University，Chengdu 610041, Sichuan Province, China.

PMID: 38537060
DOI: 10.1097/JS9.0000000000001403

Abstract

Objective: Current meta-analysis was performed to systematically evaluate the potential prognostic factors for overall survival (OS) among resected cases with gallbladder carcinoma (GBC).

Methods: PubMed, EMBASE, and the Cochrane Library were systematically retrieved and hazard ratio (HR) and its 95% confidence interval (CI) were directly extracted from the original study or roughly estimated via Tierney's method. Standard Parmar modifications were used to determine pooled HRs.

Results: A total of 36 studies with 11502 cases were identified. Pooled results of univariate analyses indicated that advanced age (HR=1.02, P =0.00020), concurrent gallstone disease (HR=1.22, P =0.00200), elevated preoperative CA199 level (HR=1.93, P <0.00001), advanced T stage (HR=3.09, P <0.00001), lymph node metastasis (HR=2.78, P <0.00001), peri-neural invasion (HR=2.20, P <0.00001), lymph-vascular invasion (HR=2.37, P <0.00001), vascular invasion (HR=2.28, P <0.00001), poorly differentiated tumor (HR=3.22, P <0.00001), hepatic side tumor (HR=1.85, P <0.00001), proximal tumor (neck/cystic duct) (HR=1.78, P <0.00001), combined bile duct resection (HR=1.45, P <0.00001), and positive surgical margin (HR=2.90, P <0.00001) were well-established prognostic factors. Pathological subtypes ( P =0.53000) and postoperative adjuvant chemotherapy ( P =0.70000) were not prognostic factors. Pooled results of multi-variate analyses indicated that age, gallstone disease, preoperative CA199, T stage, lymph node metastasis, peri-neural invasion, lymph-vascular invasion, tumor differentiation status, tumor location (peritoneal side vs hepatic side), surgical margin, combined bile duct resection, and postoperative adjuvant chemotherapy were independent prognostic factors.

Conclusion: Various prognostic factors have been identified beyond the 8th AJCC staging system. By incorporating these factors into a prognostic model, a more individualized prognostication and treatment regime would be developed. Upcoming multinational studies are required for the further refine and validation.